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The implicit bias frame does not offer equity. It offers absolution from complicity in systems that harm people. And yet, individuals, organizations, and institutions continue to use the implicit bias frame to make sense of inequity and to address it.

Take police violence, for example. In the face of the devastating and disproportionate toll police violence takes on Black and Brown people in America, policymakers have responded by offering local law enforcement implicit bias training. The underlying assumption is, police violence is an interpersonal problem that takes place between an individual “bad” officer with bias and the civilian on whom their bias is projected. In this framing, the solution then requires an interpersonal remedy to address unconscious racial stereotypes that must drive racial inequity in police violence.

But this limited reading of the problem and solution, rooted in individualized and unconscious judgement, ignores the collective impact of police violence and the explicit choices that structure, authorize and weaponize police-community relations.

Police violence is also, and I would argue, largely, a structural problem, whose effects extend beyond individual civilians to the communities and populations who directly and indirectly suffer the burden of the disproportionate risk of this form of violence. This community and population-level impact is driven by intentional human design.

Police violence must be understood as the predictable by-product of policies that introduce militarized weapons into local precincts and permit use of force in the absence of a lethal threat. Racial inequity in police violence is then incentivized by “tough on crime” and “zero tolerance” politics that penalize poverty and Blackness. This inequity is exacerbated by municipal procedure to use petty offenses to generate city revenue. And it is perpetuated by law enforcement culture that fails to demand officer accountability.

Each of the preceding system-level factors are determined by explicit human choices, not implicit beliefs. Therefore, attending a training on implicit bias or simply substituting a Black or Brown officer for a white one, because they presumably harbor less anti-Black bias, does not address the systems-level choices at the core of police violence or the racial inequities those choices create.

Similarly in medicine, implicit bias training will not help institutions unpack their problematic relationship to entrenched local poverty and racial inequity – both drivers of racial health disparities. Those relationships, between hospitals, poverty and racial inequity, are structured by intentional business models and tax designations, not unconscious preferences or prejudices. And diversifying the physician workforce without disrupting the various manifestations of white hegemony that currently set clinical priorities, research agendas, and promotional criteria, will not magically narrow racial disparities in health outcomes.

One cannot simply change a cog in an assembly line and expect the line to produce a new product. Systems function as they are designed to. To get a new outcome, it requires building a new system or transforming the existing one – each of which relies on humans making different explicit choices, regardless of their implicit leanings.

Advocates, we can no longer afford to use an individual or interpersonal analysis of harm, like that offered by the implicit bias frame, to understand and confront inequity. It fails to capture the collective experience of harm and works to conceal the ways explicit choices encoded in process, reproduce harm, across systems and populations.

While the implicit bias frame may have gained traction because the solutions it offers are relatively simple, like admitting unknowing harm in one on one interactions. The frame ultimately fails where it absolves us from confronting our knowing role in maintaining systems that inequitably distribute harm among populations. That task is more complex and requires us to challenge our individual, organizational, and institutional choices to create and uphold legacies of oppression and privilege. We all must be accountable – to each other and to ourselves, for the systems we create, the systems we protect, and the systems we participate in that harm others. Because ultimately, the goal is not to simply adjust the ratio of good to bad apples, but to change the kinds of trees we are planting.

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The opinions stated here only reflect mine and are not representative of any of the institutions I have attended or currently attend. Also, although I am a licensed physician, any generalized opinions I offer are not meant as medical advice to treat or advise patients. Medical decisions can only safely be made in consultation with a doctor you know and trust. Also, links to other websites do not imply that I endorse any of the views expressed there or products advertised there.